Breast Cancer Neoadjuvant vs Adjuvant Therapy

Two timing strategies

Neoadjuvant therapy is given before surgery; adjuvant therapy after. Both aim to reduce recurrence, but they serve different goals.

When neoadjuvant is preferred

• Shrink a large tumor to enable breast-conserving surgery.
• Assess treatment response in vivo, which informs prognosis.
• Convert inflammatory or locally advanced disease to operable.

When adjuvant suffices

Early-stage disease that is already operable often goes straight to surgery, with systemic therapy added afterward to address micrometastatic risk. Pathologic complete response after neoadjuvant therapy is a favorable prognostic sign.

Staging with the post-treatment yp classification captures the response.